Terminally Ill Adults (End of Life) Bill (Twenty-ninth sitting)

Jake Richards Excerpts

Committee stage
Tuesday 25th March 2025 Public Bill Committees

[Daniel Francis (Bexleyheath and Crayford) (Lab)]

It is a pleasure to serve under your chairship, Sir Roger. This has been a long process, and we are nearly at the end of it now. Members will recall that at the start of the process, I was very insistent that Mencap should give oral evidence. When it did so, Dan Scorer said:

“Clause 35 is about the review of the Act. The lived experience of people is absolutely vital to that. The Bill says that it will be five years until we have that review. Our view is that that is far too long. If the Bill becomes law and if there are really serious issues and discrimination taking place against people, we will want to know that a lot earlier than in five years’ time, and we will want action to be taken. Our suggestion is that review should be earlier. We would want to see strong representation from patient groups across that, as well as from people who have been involved in the process, such as family members, advocates and clinicians to make sure that if serious issues are being raised, they can be picked up early and addressed.”––[Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 30 January 2025; c. 280, Q367.]

[Jake Richards (Rother Valley) (Lab)]

My hon. Friend is, as ever, making really important points. Is he reassured by the fact that the commissioner will be reporting annually, as per the previous clause, and that the panel will give reasons, which will likely be public?

[Daniel Francis]

The annual reporting does give us some reassurance, but when we accepted some of Mencap’s recommendations last week, I said that I would welcome it if the entirety of its recommendations were accepted—and it wanted an overall review at an early stage in the process.

Amendment 493 to 495, in my name, address those concerns. A consistent concern of mine is how we address issues that come to light from specific communities, particularly those with learning difficulties, and amend the legislation at a reasonable stage in the process.

--- Later in debate ---

[Danny Kruger]

In a moment. The potential—as would happen in other parts of genuine healthcare—is that the more work people do, the more money they get. My concern is that that induces a dangerous incentive into the system. Having a global fee paid to a provider who managed the service would be much safer. The crucial point is that we prevent people being paid for approving and enabling assisted deaths, and that is what my amendment would do.

[Jake Richards]

I appreciate the point that the hon. Member is trying to make and I think it is a fair one, but how does he think this could work? As he said in his own intervention, people might have to be paid for one part of the process, and then for the next. If we appreciate the principle that people get paid for time, there is inevitably more money involved as the process goes on, so can he explain how his amendment would work?

[Danny Kruger]

I intend, in a later debate when we come to the new clause, to try to explain how I think we should have done this. The answer to the hon. Gentleman’s question is that an organisation should be resourced—I think through philanthropy, rather than taxpayers’ money or people paying out of their own pocket, but the point stands however we do it—to deliver the assisted dying service, but crucially it should not be paid more per service, treatment or customer. We should not have the concept of customers in this arrangement; there should be a provider who is resourced to deliver this service. The crucial point is that they should not be paid more per client or for progressing people through the system.

--- Later in debate ---

[Jake Richards]

I rise to speak briefly in support of amendment 548, tabled by my hon. Friend the Member for Spen Valley. I do so fundamentally for two reasons.

First, there may be a lot of support for the principle of assisted dying among members of the Committee and, indeed, Members of the House, but there are also understandable concerns about its implementation. We have been debating all the aspects of that over a lengthy period in Committee, and it is undoubtedly complex. Although my hon. Friend is disappointed that she has had to table the amendment, I commend her for doing so, because it is important to get this right and to be brave by setting longer time limits if necessary. I think that can be reassuring to Members who, while supporting the principle, want to make sure that we get this right. I hope that the amendment will do that.

Secondly, for those people—including those who have been in the Public Gallery today, Committee members and, indeed, other Members of the House—who might be disappointed about the delay, in my mind the amendment is not an obstacle to change. In fact, what we have seen here is the Bill’s promoter working with the Government, who remain neutral on the principle but want to make the Bill deliverable, to come up with a sensible, pragmatic proposal for how and at what speed this profound change is to be implemented. In my mind, that gives a sense of the Executive and the promoter thinking about the practicalities.

I urge those who are desperately seeking this change and have fought for decades to secure it to approach this measure with a sense of optimism. This is serious. This is a once-in-a-generation opportunity to deliver that change. I hope that, both in the Committee and outside it, they will support my hon. Friend the Member for Spen Valley, who has gone to great lengths to build support and to make sure that the Bill is workable. I will be voting for amendment 548 with a great sense of reassurance, but also a great sense of optimism that one day this country will see this change, which is so desperately needed.

[Liz Saville Roberts]

I rise to support amendment 535. I do not intend to say much, because the hon. Member for Richmond Park has made many of the points I wished to make. The amendment recognises that an opinion was stated in a debate in the Senedd in October, which dealt in detail with the principles of this Bill, and that Professor Emyr Lewis told us that one way of recognising that would be to consider different commencement provisions in Wales.

Reference has been made to the different criminal law arrangements in England and Wales to do with smacking children, and during covid there were quite definitely different arrangements between England and Wales. After a quarter of a century of devolution, we have devolution divergence, and we are seeing that in action.

We have already accepted the principle that there are aspects of the Bill that are devolved, responsibility for which must be passed to Welsh Ministers. We are still debating the wording of that, but we are working towards it, and I think we have accepted the principle of it. We should also acknowledge that the Senedd and Welsh Ministers may well be able to make a move that would have the same effect of changing the commencement date, but I support the amendment because it shows that we are acknowledging the consequences and implications of a legislative consent motion. Incidentally, I could often stand up here and talk about the fact that legislative consent motions can be overridden by Westminster, but we are working from the point of view of seeking to respect devolved powers alongside the powers that we have here, so I will be supporting amendment 535.

Male Suicide in Rotherham

Jake Richards Excerpts

Monday 24th March 2025 Commons Chamber

[Jake Richards (Rother Valley) (Lab)]

In Rotherham, male suicide is a silent tragedy on the rise. As the local MP, I receive too many calls or messages early in the morning or late at night, telling me about another husband, father, brother or friend who has died in these tragic circumstances. Each call haunts us and our communities, but it is nothing compared to the unimaginable sense of grief and agony suffered by family and friends. The growing phenomenon of male suicide is part of a wider storm we face: of worsening mental health and mental health provisions for men; of splintering communities and support networks; and of a society that too often makes some men feel that they are unable to open up or reach out for help, or indeed that they are themselves part of the problem.

Tonight I want to make the argument for further Government action, and also offer a call to arms to us all. We can all do more to check in on our neighbours, friends and colleagues, and to build safe spaces for men to talk, to feel valued and to know that it is okay not to feel okay and that there is help. We should never forget the tragedy of women taking their own lives, too, and the particular circumstances that only women face that might lead them towards doing so. That matter is worthy of its own debate, though much of what we discuss will of course be relevant.

The numbers for men are startling and worth stating bluntly: suicide is the biggest killer of men aged under 50. Men account for three out of four suicides in England and Wales. A hundred men end their lives each week across the country. In Rotherham, men account for 79% of suicides.

[Lee Pitcher (Doncaster East and the Isle of Axholme) (Lab)]

In Doncaster last year, 80% of those who died from suicide were men, and we of course have one of the largest numbers of veterans in the whole of Yorkshire and the Humber. Doncaster council has the armed forces covenant. Will my hon. Friend join me in promoting its work, particularly around the veteran-friendly suicide prevention training that makes a huge difference to all the people who take part in it?

[Jake Richards]

My hon. Friend makes a good point. Just on Friday, I had the Defence Secretary, who is with us today, and the Veterans Minister in Dinnington to speak with veterans groups and organisations. Mental health provision was right at the top of the agenda, as it should be. Beyond each individual tragedy is a wider story. There is a specific challenge for policymakers in grappling with male suicide.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Gentleman, who I spoke to beforehand. This is his first Adjournment debate, and it is on a subject that every one of us understands only too well. I am saddened to hear the vast number of reasons contributing to male suicide in his constituency. There is certainly more to be done to support men across the UK. Suicide happens everywhere and especially in men—70% of the suicides in Northern Ireland are men. The majority of them occur in deprived areas. Does he agree that we need greater accessibility to mental health services in deprived areas to ensure that men are not left behind?

[Jake Richards]

I agree with the hon. Member, who makes a characteristically pithy point.

John Leaver, who does incredible work with men in tough times in Kiveton Park and Wales in my constituency, is in many ways the inspiration for the debate and the campaign I intend to run in Rotherham. John works with men and women, but has extensive experience of the particular issues that men face in his area. He has often been the person telling me of another suicide, and not infrequently it is somebody he knows well, played football with, went to school with or is an old family friend. He spoke to me about the effect of the decline of post-industrial towns and villages, such as Kiveton Park, Dinnington, Maltby and Thurcroft in my constituency, on men and notions of masculinity. Those places were built on the back of coalmining—a proud tradition of honest hard work, offering a sense of purpose and meaning for generations of young men. We should not simply look back with rose-tinted spectacles, but after the closure of the pits, we have too often struggled to replace that social fabric for men. These remain brilliant communities with a long-standing sense of solidarity and camaraderie, but too many within them still feel lost.

Even worse, too many men feel victimised or attacked. I was recently struck by the words of musician Sam Fender in a newspaper interview. Speaking about the towns in the north-east of England that he grew up in, he said lads were

“being shamed all the time and made to feel like they’re a problem. It’s this narrative being told to white boys from nowhere towns.”

I fear there is some truth to that—that men from towns built in a bygone era feel they are a problem in modern times. I want to play my part as the local MP in changing that, and I am not alone. Brilliant organisations in my constituency already do fantastic work. Andy’s Man Club in Maltby and Kiveton Park meet every Monday evening. Better Today, run by John Leaver, is incredible at supporting men in times of real difficulty. There are many fantastic sports clubs and associations, from boxing in Dinnington to Swallownest FC and Maltby Main FC. There are the regular coffee mornings, the walking and rambling clubs, and the monthly men’s breakfast in Anston. They all play a vital role in supporting men in difficult circumstances.

[Mark Sewards (Leeds South West and Morley) (Lab)]

Veterans have already been mentioned by my hon. Friend the Member for Doncaster East and the Isle of Axholme (Lee Pitcher). Would my hon. Friend join me in paying tribute to Veterans In Need Together? He talks about organisations that support men. That organisation supports men every Wednesday at Morley fire station without fail and offers support to those who need it.

[Jake Richards]

That service in my hon. Friend’s constituency sounds vital—just like those in my constituency. The focus on veterans in particular is critical.

Suicide does not simply affect the person taking their own life. Families lose loved ones and towns and villages are scarred by the traumatic loss of people with great promise and talent. The number of men who kill themselves every year is eclipsed by the number of people affected by their loss. I will use my role as the local MP to press the Government to take action. There are specific policy issues that I want to raise.

I am very aware of specific issues to do with gambling and male suicide. I have met two local mothers who are fighting for justice after their sons, both of whom were hard-working, talented and honourable men, took their own lives far too young as a result of spiralling online gambling addictions. Social media and technology have allowed vulnerable users easier access to gambling. A report found two years ago that there had been a 43% annual rise in demand for NHS gambling clinics, and that one in three of those patients had already attempted to take their own lives. It is estimated that every year there are more than 400 gambling-related suicides in England—and those are the ones we know of. I have before urged the Government to consider ways in which we can empower coroners courts, and indeed place responsibilities on coroners, to look at these issues in a robust and rigorous manner. At the moment, the causative link between gambling addiction and suicide is not given appropriate recognition.

There are broader issues. Although the issue of men’s mental health is complex, there are specific policy areas that the Government must confront. First, the rates of men taking their own lives are highest in the most deprived communities. The suicide rate in the most deprived 10% of areas in England in the two years from 2017 to 2019 was 14.1%—almost double the rate in the least deprived areas. Indeed, rates of men taking their own lives in the regions of England are almost double what they are in London. Tackling poverty and insecure work across our country is a Labour mission, and it is one that will save lives.

[Dr Danny Chambers (Winchester) (LD)]

I thank the hon. Member for giving way and for speaking so eloquently about this difficult and sensitive subject. On that point, it is known that those living in poverty are three times more likely to take their own lives or have mental health issues than people on the average wage. Linking into that, 85% of homeless people are men, and their homelessness is often related to mental health issues. I appreciate all the work that he is doing to highlight poverty.

[Jake Richards]

There is a direct link and we should not shy away from acknowledging, confronting and talking about it. When we talk about tackling poverty, we are talking about saving lives, too.

Secondly, we must save our NHS. This Government inherited a dilapidated health service and a particularly severely under-resourced mental health service. Fourteen years of under-investment and chaotic reform have hindered efforts to grasp this crisis. Long delays for treatment and diagnosis mean that so many men cannot get the support that they need and face worsening mental health in the meantime.

Thirdly, in my view we must be bolder in acknowledging the role that technology and social media have played in this crisis. New technology and social media can help efforts to combat men in difficult times: the internet can allow faster access to mental health provisions and can provide a network. However, it has been clear for more than a decade now that technology and social media can be deeply damaging to mental health, eroding confidence, often siloing rather than enhancing our communities, and exposing people to potentially harmful material. I know that many colleagues in the House have been moved by the Netflix drama “Adolescence”, which shines a light on the way the internet can remould ideas of masculinity and purpose—completely unbeknown to those closest to the 13-year-old boy in that drama.

Men, especially our young men, are spending less time outside and less time meeting people and communicating in person—all things that make us far happier and healthier. They are often sat alone for hours being bombarded with algorithms showing unrealistic representations of life, or communicating through anonymous group chats. Research shows that self-harm content has sometimes been allowed to flourish on social media by companies failing to remove explicit images and encouraging those engaging with such content to befriend one another. The arrival of smartphones has taken place in parallel with sharp rises in depression and anxiety in our young people. Of particular concern is the impact that mobile phones have on our young people. The average 12-year-old now spends 29 hours a week on their phone—equivalent to doing a part-time job.

[Liz Twist (Blaydon and Consett) (Lab)]

I commend my hon. Friend for securing the debate and for speaking so powerfully. Does he agree that we must also consider the employment-related, sectoral issues in tackling male suicide?

[Jake Richards]

Absolutely, and my hon. Friend has done so much admirable work in this area, long before my time in the House, so I can only learn from her. One point about suicide and male suicide is that an array of policy issues feed into it. This should not be a policy concern for the Government in silo; it should be part of every policy area, and every Department should have those concerns about mental health and suicide protection at its heart.

I was talking about mobile phones and the effect they have had. Since 2010, the average time that teens spend with friends each day has fallen by 65%. I applaud recent Government announcements about reviewing those policy areas, but I urge them to grasp the nettle when it comes to technology, phones, young people and mental health. In a decade’s time I believe we will wonder why we did not do so far sooner.

[Chris Coghlan (Dorking and Horley) (LD)]

I thank the hon. Member for securing this debate. I am working closely with him on the Mental Health Bill. Does he agree that one issue for families who are worried about their loved one is that when they are over the age of 18, there can be barriers in law in terms of the presumption of capacity and the Mental Capacity Act 2005 when it comes to raising the alarm with public authorities?

[Jake Richards]

I am grateful to the hon. Member, who has a remarkable ability to bring that important issue into any debate or intervention he makes. He is the most vociferous campaigner on that cause. I support him in that, and I know the Minister will also be listening.

I want to finish with the action I will take as the local MP. First, I pledge to continue to support the brilliant services we already have. I remember attending my first Andy’s Man Club in Maltby during the general election campaign. I must admit I was slightly cynical. I had seen the marketing, but questioned how effective or useful that informal meeting would be. I was blown away. Over the course of a few hours, a group of blokes spoke about their weeks, and their problems, over a cup of tea. Some of the chat was mundane: they were finding their work more boring, or they had had a good weekend with the family. Others were dealing with the most impossible trauma that put all else—in particular my election campaign—into stark perspective. Afterwards, everyone walked away ready to face the week, however big the challenges ahead. I have since met so many men who use that service. One of the first things I did once elected was to bring Andy’s Man Club to Parliament. I promise to continue to champion its work, and the work of many others.

I also regularly meet local health practitioners in Rotherham to hear their strategies to bring down the rate of men ending their own lives locally. The work of Rotherham health and wellbeing board, and the South Yorkshire integrated care system is hugely commendable, not least the emphasis on improving data and evidence to ensure effective and timely interventions, and providing tailored, targeted support to priority groups and effective bereavement support to those affected by men taking their own lives. Those plans sit within strategies to tackle loneliness, health inequality and domestic abuse. I have committed to holding regular meetings with all GP practices in my constituency, and other support groups, to help tackle male suicide.

We will hear from the Minister shortly about the Government’s national efforts, and from conversations with him I have no doubt that he grasps the severity of this crisis and the urgency with which this Government must confront it. Rest assured, I will be challenging the Government every step of the way to be ambitious in this agenda, and to ensure that policies will work for every town and village in Rotherham. Locally, I will be setting up my Rotherham taskforce to hold authorities to account, working with men and women who are on the front line confronting this issue. We will lead the ongoing awareness campaign and ensure that professionals, and local and national Government, treat this issue with the seriousness it deserves. I am grateful for the opportunity to speak about this important issue, and I hope that by doing so we begin more conversations across our borough. Together, we can bring about meaningful change, and save lives.

[Amanda Martin (Portsmouth North) (Lab)]

rose—

Terminally Ill Adults (End of Life) Bill (Twentieth sitting)

Jake Richards Excerpts

Committee stage
Tuesday 11th March 2025 Public Bill Committees

[Lewis Atkinson (Sunderland Central) (Lab)]

It is a pleasure to serve under your chairship, Sir Roger.

I rise to speak to a couple of the amendments. Amendment 348 is likely unnecessary. I would have been minded to support it had it referred to a registered GP, but the language of “usual or treating doctor” is unconvincing. I am not sure what those terms refer to. The registered GP absolutely should be informed, and both normal practice and the provisions in the Bill about entering information into medical records would mean that that is the case. For me, “usual doctor” is not the right terminology; it does not achieve what I think some of its proponents want. With reluctance, I will vote against that amendment because it does not refer to a registered general practitioner.

On amendments 303 and 458, I believe there must be provision for a second opinion. However, I am persuaded by the points made by the hon. Member for Richmond Park about amendment 459. I slightly disagree with my hon. Friend the Member for Stroud: although the independence of the second opinion is important on matters such as the terminal prognosis, when it comes to the detection of coercion, the more information, the better. It is one thing to be independent in a medical assessment, but the amendment speaks to a psychosocial assessment. We are trying to detect coercion, so it is important that every decision maker gets further information as the process progresses.

The provision for five different touchpoints of assessment is one of the strengths of the Bill. Each assessment should be done in a way that can be progressed with more information. It is not just five different independent points of information; because of the Bill’s record-keeping provisions, the assessment should become increasingly informed throughout the process. I certainly think that the panel, or whatever we get to, should have sight of any negative assessment from an independent doctor, as well as any positive one. The panel will then be able to do its job of scrutinising the two decisions, potentially weighing them up, and calling the different doctors who have given different decisions. I am, then, persuaded by amendment 459.

[Jake Richards (Rother Valley) (Lab)]

It came up in the debates last week that we heard some evidence from medical practitioners on how decisions and assessments were better made when done collaboratively. That means that we need to keep them independent but that, where possible, doctors should be working together in this process. Does my hon. Friend agree that amendment 459, tabled by the hon. Member for Richmond Park, may assist in that?

[Lewis Atkinson]

Yes, I do. I recognise the importance of independent assessment for prognosis and capacity. However, particularly with the issue of coercion, healthcare is a team sport, as anyone who has worked in healthcare knows. The more information and the more viewpoints we can get in those instances, the better. One of the strengths of the Bill is the team sense around it, which we will further in the amendments to clause 12 that we will come on to in due course.

I will finish briefly on amendment 460. I do not see the loophole that has been described. I think we would all want someone to be able to cancel their first declaration, and they are more likely to do so if they feel they have the option of going back and making a future first declaration. My worry with amendment 460 is that, by removing the word “particular”, it suggests that people are only able to make one first declaration in the course of their life. With the periods of reflection built into the Bill, which Members spoke about earlier, if someone changes their mind, they should cancel their first declaration. They are absolutely free to do so and the Bill, as currently drafted, makes good provision for that. To me, amendment 460 would remove the ability for that person to come back to that decision at a later point and go through the assessment process again. While I understand the motivations behind amendment 460, I am cautious about it for those reasons.

--- Later in debate ---

[Naz Shah]

Sorry, I will just finish my point.

From a common sense perspective—I am not medically qualified—that situation should make me, as a human being, want to understand more. As a human being, I would like to understand whether something else was going on, such as anger towards—

[Jake Richards]

Will my hon. Friend give way?

[Naz Shah]

Sorry, I will not give way until I have finished my point.

I would like those conversations to be at least explored, which is why I support the amendment.

--- Later in debate ---

[Jake Richards]

Does my hon. Friend agree that she is making a powerful case against amendment 468? A multitude of conversations and different circumstances will need to be taken into account; it is wholly inappropriate to have a mandated question in primary legislation. We should go back to clause 1, which I think the Bill is actually about. It states that the person must have

“a clear, settled and informed wish to end their own life”.

Does my hon. Friend agree that that is what is at the heart of the Bill, rather than decisions about what is in the person’s best interests?

[Naz Shah]

I respectfully disagree. I am making the case that there is a conversation to be had. Yes, there is informed choice but is my hon. Friend suggesting that the question should not be asked at all? I take the point that with an informed choice there would have been an exploratory conversation, but sometimes just calling something out, or stating the obvious, makes a huge difference.

Terminally Ill Adults (End of Life) Bill (Twenty First sitting)

Jake Richards Excerpts

Committee stage
Tuesday 11th March 2025 Public Bill Committees

Requiring the doctor, when considering a patient’s request for assistance to end their life, to decide whether it is appropriate to advise them to discuss it with their next of kin introduces several problems. It places a subjective burden on the doctor. The term “appropriate” is very vague. Does it hinge on the patient’s family dynamics, their emotional state or indeed the doctor’s own biases?

[Jake Richards (Rother Valley) (Lab)]

The amendment that the hon. Member is supporting speaks of a doctor having to consider what is

“in the person’s best interests”,

which is wholly subjective. Does he not agree that the same difficulties he identifies with the current drafting are extrapolated greatly by the amendment?

[Danny Kruger]

I am afraid there is a huge degree of subjectivity throughout the Bill, and we are putting an enormous obligation on doctors to use their best judgment. However, I think it is right to stipulate more clearly that it is appropriate, in general, to inform patients’ families. Leaving the vague term “appropriate” essentially implies that it is either/or—that it is a 50:50 choice whether they do so. So it is important to specify that the expectation is that they should do so. Of course, there will be circumstances in which that would not be the right thing to do, but as the amendments make clear, they should explain that clearly if they are not going to do so.

A doctor might hesitate to suggest a discussion with family if they suspect that there are strained relationships within it. My concern is that, without clear guidance, that judgment could be inconsistent or legally challenged. The doctor might know the next of kin and believe that they would try to stop the patient from ending their life. We have heard quite often the concern about the family being some sort of coercive force, trying to prevent people from fulfilling their autonomous choice to end their life, and that we should put in place barriers to stop families trying to dissuade their loved one from assisted suicide. We heard that repeatedly, particularly from the Australian witnesses.

My concern—this goes specifically to certain communities within our country—is that doctors from individualistic cultures, which we have in western Europe and North America, would prioritise personal autonomy. They would deem it inappropriate to suggest family involvement, viewing that as an intrusion on the patient’s rights. We need to state clearly that that is not the expectation and that the expectation is that they should consider involving the family in the discussion.

My concern is also about an exaggerated respect for medical confidentiality. As the Committee knows, my belief is that this is not a healthcare treatment at all, but if it is to be regarded as such, we should not assume that medical confidentiality applies in an absolute sense. There are specific differences between this so-called medical treatment and others, which do justify an override of the assumption of total medical confidentiality. It is therefore appropriate, as in certain other medical procedures, that family members should be involved.

I want to cite the written evidence from Dr Rosemarie Anthony-Pillai, who pointed out that clause 9

“lays bare the reality that in trying to, rightly, diminish any accusation of coercion or family disagreement, this Bill will lead many to a lonely death.”

She also said:

“Families/loved ones finding out only after the event how the person died will have its own bereavement issues that this Bill in no way seeks to consider.”

I also cite the written evidence we had from AtaLoss, which is a UK charity dedicated to ensuring that bereaved people can access support. It said that discovering the decision that somebody has had help to take their own life without prior warning

“can replicate the distress often associated with sudden or suicide-related deaths, thereby intensifying bereavement trauma and potential suicide contagion.”

That is a very significant threat. We will not rehash the argument about whether suicide increases in countries with assisted suicide, but my strong view, from the evidence, is that it does.

In terms of the patient’s safety, if the process is kept secret even from those who know the patient well, the assessing doctors and the panel will be asking very difficult questions about the patient’s feelings and circumstances partly blindfolded. If a patient is in a controlling relationship, they and the person abusing them are not going to volunteer to the doctor or the panel that there is any pressure going on—indeed, the patient may not even understand it to be pressure. It is very common for an abusive partner to try to isolate the victim from their close friends and family. The hon. Member for Ealing Central and Acton (Dr Huq) wrote recently about how this has come up in her constituency. The ex-husband of her constituent’s sister reappeared on the scene, charmed and isolated this woman, and got her to change her will in his favour. That is a technique of coercive control. Some level of required notification to the wider family would make it much harder for a controlling partner to push someone through this process without it being exposed.

It was made clear earlier today that the Bill’s supporters do not want any hard-edged reasons that count as bad reasons to die to be stated in the Bill—they do not want it asked at all why someone wants to have an assisted death. As it stands, the doctors and the panel would have to approve the death as long as it was the patient’s clear, settled and informed wish, but involvement of those who know the patient well might demonstrate that it was not clear, settled or informed. They may have regularly gone through patches of feeling unloved and unsupported all their life, and that could change. That is information that only the wider family would know.

To conclude, there is real suffering hereto—as I have said, nobody exists in a vacuum. I want to reference the opinion of Judge Elósegui in the European Court of Human Rights. Her opinion was a partial dissent in the Mortier case, which has been discussed before. She said:

“it should be underlined that it cannot be said in an exhaustive way that the principle of autonomy always and at all costs has primacy over the other three principles of bioethics. In particular, we must take into account the consequences of our actions on the rest of the family unit and on our circle of friends.”

That is highly relevant. If we see cases where somebody dies by assisted suicide, and the first thing their child or parent knows about it is they are told to come and collect the body, that will be a scandal. That has happened in other countries, and the Mortier case is a case in point.

I mentioned other cases in which it is obligatory to consult and inform family members. At the moment, that is what happens at the Court of Protection with much less serious applications. Practice directive 9B requires doctors to notify

“at least three persons who are likely to have an interest in being notified”.

That is in the case of organ donation and other procedures. Families are required to be notified, and an indicative list is given, which is supposed to be worked through in order—spouses, people who live with as a spouse, parents, children and so on. The authorities are to jump along through that list, again with some discretion given to them.

To end, on the standard guidance referred to in judgments on that procedure, the judgement of Senior Judge Lush in the Court of Human Rights included the observation that the decision not to notify someone who would otherwise be entitled to be notified is not something that just affects the applicant. It is not just about their interests; there is a wider concern for the whole of society and indeed the family. That is why I support the amendment.

--- Later in debate ---

[Lewis Atkinson (Sunderland Central) (Lab)]

It is a pleasure to serve under your chairship this afternoon, Ms McVey.

I feel that we are dancing on the head of a pin, but I oppose the amendment. Members across the debate have recognised that, as Dr Sarah Cox from the Association for Palliative Medicine said, it is always for the patient to decide. As my hon. Friend the Member for Rother Valley pointed out, both the original clause and the amendment rightly retain that decision with the patient. They also retain the discretion of the doctor, whether that is on an appropriate test or a best interests test.

I note that in its submission the Royal College of Physicians advocated the removal of the clause, saying that it goes beyond current practice. I support the clause on balance, because of the importance of these conversations and so on, but the physicians who are likely to carry out the conversations think that it is inappropriate to specify these conversations in primary legislation.

There are two phrases in the amendment that I think are entirely inappropriate. First, there is “concluded in good faith”. I am sure it is not the intent of the author and mover of the amendment, but it suggests that in other instances people might be acting other than in good faith. I commend the words from my hon. Friend the Member for Ipswich. We have to start from the point that doctors are operating in good faith. It is dangerous to set up a good faith test, as opposed to an “other faith” test, in primary legislation.

Secondly, I am certainly not trying to reopen the long debates we had about the Mental Capacity Act, but Members will recall that in those debates we were very clear that the “best interests” test should not and does not apply. Introducing language about best interests the first time in the Bill is very dangerous, and totally against the spirit and principle of what we have debated so far. For those reasons, I am against both amendments.

[Jake Richards]

My hon. Friend the Member for Sunderland Central has made many of the points that I planned to, so I will be brief. The primacy of patient autonomy when it comes to familial relationships is a principle that should not be interfered with in the medical sphere, which this is—we can call it treatment or something else, but it is undoubtedly a relationship between a doctor and a person.

I agree with my hon. Friend on the term “good faith”. I do not doubt the motives, but it put forwards the proposition that a doctor would act in bad faith and not tell a family member. It is a rather bizarre drafting, and wholly unhelpful for the intent for which it was put forward.

The most alarming is the second part and the issue of “best interests”. I will not labour the point that my hon. Friend has made, but what is a doctor to do? A doctor is not a social worker. A doctor is not a family support worker. What questions are they to ask? If someone says, “Oh, I don’t really want to tell my next of kin, who is my sister. We fell out last year because of tit for tat,” is the doctor going to make a value judgment as to whether that argument is profound enough to stop the notification?

[Tom Gordon (Harrogate and Knaresborough) (LD)]

The point that the hon. Member makes is, I think, exactly the case—raising this conversation and talking about it is probably not in anyone’s best interests in the first instance. I think about my own situation. If I were to find myself terminally ill and falling within the scope of this law, and my mum had passed away, then my dad, who I have not spoken to in over a decade, with whom I have a very difficult and estranged relationship, would have to be notified and we would have to have a conversation about it. On my deathbed, the last thing I want to be thinking about is some childhood trauma being brought back before me in the confines of that terminal illness. Does the hon. Member agree that, while the intention might be good, the consequences could be damaging to the patient and their best interests?

[Jake Richards]

I agree. I think in some of these debates—I am probably guilty of this as well—we forget the context in which we are operating: someone is dying, imminently. Therefore, how we approach these conversations, these assessments and this process must take that into account.

[Danny Kruger]

The hon. Gentleman accurately points out that doctors are not social workers or psychiatrists, and we are asking them to make a difficult judgment, in consultation with the patient, about whether they should engage wider family in the discussion. That goes to the broader point: we are imposing a huge obligation on doctors to make very complicated decisions about capacity, coercion and the psychosocial circumstances of the patient. The value of this amendment’s saying, “I think we should involve the family if it is safe to do so”—it might very well not be in certain circumstances—is surely to assist them in having the wider conversation that is necessary.

--- Later in debate ---

[Jake Richards]

As we heard in evidence from the chief medical officer, doctors deal with capacity issues on a day-to-day basis; I am not sure they necessarily need assistance from family members in that regard. However, I appreciate the point—I was going to come to that—

[Daniel Francis]

Will my hon. Friend give way on that point?

[Jake Richards]

I am going to make some progress, because I am not sure that point is crucial to the debate about this amendment; I am sure my hon. Friend will grab me afterwards. I did not mean to mischaracterise the evidence on that point.

I accept that there is a tension here. No man is an island, as the hon. Member for East Wiltshire notes, and of course this process may cause upset to others. Equally, the input of third parties to the assessment of all the issues of eligibility is worth while, but it has to be dealt with in a proportionate way. When we debate clause 12—hopefully shortly—perhaps we can discuss that, and I hope to speak to that point.

However, this amendment is trying to crack that delicate nut with a huge hammer. It fundamentally changes the relationship between doctor and patient, and puts the doctor in a position where they do not have the skills or expertise to make that best interest decision. The amendment therefore fails, and that is why I will vote against it.

[Rebecca Paul]

I am concerned that maybe I am misunderstanding the debate. For clarity, right now clause 9 says that

“in so far as the assessing doctor considers it appropriate,”

they should

“advise the person to consider discussing the request with their next of kin and other persons they are close to.”

It will read very similarly if the amendment is agreed to. Instead, it will say,

“unless the assessing doctor has concluded in good faith, that this would not be in the person’s best interests, advise the person to consider discussing the request with their next of kin and other persons they are close to”.

That is a very subtle change—it is just a little more encouragement to consider contacting the family. No one here is telling the doctor that they must tell the patient to contact the family; it is just a little bit of strengthening to encourage that. I invite the hon. Gentleman to confirm if I have misinterpreted, but that is my understanding of the clause.

[Jake Richards]

I will double check whether this is right, but the explanatory statement suggests that that is not the case. It says:

“This amendment would require the assessing doctor to inform the person’s next of kin that the person wishes to seek assistance to end their own life unless it is not in the person’s best interests.”

[Rebecca Paul]

That is not what it says.

[Jake Richards]

Even if that is not what it says, and even if the explanatory statement is wrong, it is not appropriate for doctors to advise patients what they should do with their family. Yes, they should consider it, but that is what this clause does. I will be voting against this amendment.

--- Later in debate ---

[Juliet Campbell]

I thank my hon. Friend for that explanation.

I move on to amendment 410, which would remove the ability of the court to hear from and question any person other than the person who made the application or the declaration for an assisted death and the assessing doctors. I have strong reservations about using a proxy or giving another person the right to speak on behalf of an individual who wishes to have an assisted death, and I question the scope of those people who could be the proxy to speak on behalf of a person requesting an assisted death. Who exactly would those people be?

One of the arguments we have consistently debated in this Committee is around coercion and patient autonomy. When multiple third parties such as family members or caregivers are allowed to testify, there is an increased risk that an individual might influence the court’s decision in a way that is not aligned to the true wishes of the applicant. In some cases we have talked about pressure from family members or loved ones, for whatever reason—whether their vested interest is financial or something else—to have the applicant hasten their death or have an assisted death. I would not want that kind of pressure to be put on the person and I do not believe any third party should be allowed to speak on their behalf or to be a proxy.

By limiting the scope of the testimony to the applicant and assessing doctors only, the amendment helps to safeguard against such manipulative tactics and ensures that the court focuses solely on the applicant’s own will and the medical assessment of their eligibility, removing the potential for family dynamics or any other outside influence to interfere with the judicial review. It offers a necessary refinement to the Bill for assisted deaths, a request that is both efficient and respectful of the autonomy of all people involved. By limiting the court testimony to the applicant and assessing doctor, the amendment addresses several of the concerns I have spoken about.

[Jake Richards]

I will speak briefly, because many of these issues and themes will be debated in clause stand part and amendments 371 and the others from my hon. Friend the Member for Spen Valley. Amendment 267 was not moved, but I would have opposed it in any event, on the basis that the discretion given there was way too wide and I did not understand the basis of the amendment in any way. Amendments 105 to 107, tabled my hon. Friend the Member for Derby North (Catherine Atkinson), attempt to add an adversarial element to proceedings. Again, I will not comment too much because that issue comes back in the fourth grouping under this clause.

I turn briefly to amendment 410, to which my hon. Friend the Member for Broxtowe just spoke. My understanding is that, although this relates to the High Court—which may be deemed redundant as we move on through this clause—the amendment aims to limit the people that the judge or panel can hear from. In my view that would be wrong and dangerous. The purpose of a judge or a panel is to explore the circumstances in this matter. That must mean that they have discretion to hear from others as well. In my view, this amendment, if passed, would significantly limit the safeguards and be quite dangerous.

As my hon. Friend has already said, amendment 407 has been superseded, and I think we all agree on that.

[The Minister of State, Ministry of Justice (Sarah Sackman)]

It is a pleasure to serve under your chairship, Mrs Harris. As I and my colleague and hon. Friend the Member for Aberafan Maesteg have made clear throughout the debate, the Government continue to remain neutral on this Bill and do not take a position on assisted dying. My remarks will therefore focus on the legal and practical impact of the amendments, to assist the members of this Committee in undertaking line-by-line scrutiny.

Amendments 267 and 105 to107, which have now been withdrawn, deal with the Bill as currently drafted in relation to the High Court. Clause 12 as currently drafted would require the High Court to make a declaration that the requirements of the Bill have been met, following a person’s first declaration to receive assistance to end their own life, with statements from a co-ordinating doctor and an independent doctor. The amendments relate to how the High Court will declare itself satisfied that a person has a clear, settled and informed wish to end their own life and that they have not been coerced or pressured.

Briefly, amendments 407 and 410 seek to change who the High Court—as others have said, we might come on to debate some of these themes relation to the panel—would engage with when considering applications for assistance under the Bill. In determining whether the person has a clear, settled, and informed wish to end their life and that they have not been coerced or pressured, the High Court would be required to hear from and question the person seeking assistance, as opposed to having the option to do so. As my hon. Friend the Member for Spen Valley pointed out, in the later provision in relation to the panel, that has now become a requirement.

As my hon. Friend the Member for Broxtowe made clear, under her amendment 410 the High Court would lose the ability to hear from or indeed question any other party other than the person seeking assistance and the assessing doctors. Removing the ability—whether of the High Court or, as we may come on to debate, of the panel—to hear from and question any other party may limit that body or court’s ability to interrogate wider evidence or points of view.

--- Later in debate ---

[Sarah Olney]

I am grateful for amendment 6 and to my hon. Friend the Member for St Albans for tabling it. I put on record, however, that I do not think that the panel that we are discussing addresses my earlier concerns. I wanted to make that absolutely clear by highlighting the further evidence from the Association for Palliative Medicine. The panel proposed by this group of amendments does not address its concerns, or the concerns of many other people who were saying that there needs to be a multi-professional team.

[Jake Richards]

I rise to speak in support of new clauses 14, 15, 17 and 21 and the accompanying amendments. I hope also to deal with some amendments tabled to new clause 21.

On Second Reading, I and many other hon. Members said that the Bill was the strongest and safest assisted dying law in the world. I want to be clear that I stand by every word of that, but this change will make the Bill far stronger and far more resilient to questions of capacity and coercion and therefore far safer. It will ensure a further independent layer of assurance: a panel of experts chaired by a senior lawyer to hold the process to account, to ensure that every avenue of inquiry has been explored and to hold professionals in our healthcare system to account when it is appropriate to do so.

The change will replace a single High Court judge, a person with no particular expertise in the issues at hand, with a panel that will adopt a more holistic approach. The social worker will delve a little deeper into the personal circumstances of each individual. The psychiatrist will ask any necessary questions about capacity. They will serve alongside a senior lawyer to ensure that the process is necessarily formal and strict. They will have the powers to make further inquiries if they so wish.

On and after Second Reading, there were legitimate questions about the High Court function—what exactly were we asking the judge to do? I maintain that a High Court judge could have overseen the process, but it is far better and more pertinent to the issues at hand to have a multidisciplinary process involving a social worker and a psychiatrist.

This is our lawmaking process working efficiently: debate has pushed my hon. Friend the Member for Spen Valley to think again. Working with the Government —whose role continues to be to ensure that the Bill will be workable if it is to gain Royal Assent, while remaining neutral on the principle—she has been creative in tailoring a process to the matters at hand. That must be welcomed.

This is new law. The change that the Bill would enact is profound and therefore requires a very new safeguarding process. This is the key point. The panel would not be there to adjudicate on a dispute, undertake a trial or undertake an inquiry; it would be there to ensure that the process is safe. A person would come to the panel seeking assistance to which they are entitled under the law, and the panel would ensure that the process through which their eligibility has been decided has been rigorous and safe.

It is also important to note that the panel would simply regulate and scrutinise an ongoing doctor-patient relationship. Even after a certificate of eligibility has been received, there is a period for reflection and continued assessment. That is crucial, because it means that normal rules of appeal are not appropriate—I will come back to some of the amendments in that regard. Even once the panel’s work is done, the co-ordinating doctor and the commissioner will remain available for reconsideration and oversight.

I want to deal with some of the criticisms that have been levelled at the change set out in the amendments tabled to new clause 21 and others. To my mind, the process should not be adversarial, because it is inherently inquisitorial. What is the dispute that is being decided? The person is deemed to have capacity by two doctors, and perhaps a psychiatrist, to make a decision, and is seeking an eligibility certificate. The starting point must surely be that the person should be allowed to do so. To set up some bizarre dispute where none exists would be counterproductive and unsettling to the person at the centre of the process. It would be a waste of public funds, but more importantly it would be a waste of time—time, in the context of a person who is dying.

The process is not analogous to the Court of Protection, where there are disputes as to capacity, best interests and welfare. It is not analogous to a court approval hearing, where there may be legal arguments as to the appropriate nature of an award or the arrangements for it. It is not analogous to a deprivation of liberty order, where in all likelihood a person would seek not to be deprived of their liberty. It is not analogous to private children’s proceedings, where the child’s welfare is paramount. This is a person seeking help for themselves. The principle of choice and autonomy at the end of life means that that process must be patient-centred and begin from an appreciation of those principles.

[Danny Kruger]

The hon. Gentleman is making a very good speech in defence of the change, but could he help me understand something? He said that he supported the previous proposal, involving a High Court judge; he is now suggesting that it would be completely inappropriate to have any sort of judicial oversight of the process. How could it have worked better?

The hon. Gentleman talks about there being no need for any sort of adversarial system, but does he not recognise that there might be another side to the story, and that it would be appropriate for somebody, whether that is a judge or someone else, to hear arguments against the application?

[Jake Richards]

Let me deal with the first point first. A High Court judge could have exercised this function themselves. As I set out in public very soon after Second Reading, I was struck by the fact that we were asking a High Court judge to do this, even though they have no particular expertise in the issues that so concerned hon. Members on Second Reading, whether they voted in favour of the Bill or against it. I thought about the process more, as we are all doing, to try to understand what it would look like in practice. What questions might be asked? Where does a panel or judge need to go? To my mind, psychiatrists and social workers are much better placed than High Court judges to know what avenues to further explore.

I have forgotten the hon. Gentleman’s second question.

[Danny Kruger]

I was making the point that there is surely some value in what the hon. Gentleman describes as an adversarial process, in which the decision maker is required to consider whether there are circumstances that the applicant is not presenting.

[Jake Richards]

I will come on to that issue. First, there are avenues for the panel to have information put before it that will be pertinent to the decision at hand and that may be pivotal to that process. That is not quite adversarial. Secondly, there is always a route for an adversarial contest in this matter through judicial review. I hope that that will be very rare, but it is certainly possible, and that has to be maintained. I think my hon. Friend the Member for Spen Valley and the Minister would accept that that would be an avenue.

The panel will have an array of information to consider. It will have two reports: one from the co-ordinating doctor and one from the independent doctor. In any event, it is often likely to seek medical records. It will speak to the co-ordinating doctor or independent doctor about capacity and any issues of coercion. Crucially, it will speak to the person themselves unless there are extraordinary circumstances that oblige it not to. One can imagine the vast array of circumstances that will come before the panel, but it will have the discretion and freedom to explore as appropriate. That will be a process that is appreciative of the specific facts before the panel.

I made this point earlier, but it is important to remember that this is a very human moment. A person is dying; they come to the panel seeking help. It is right to ensure that there are hurdles to consideration for eligibility, but the idea that a person should be forced to win a trial or a case, or see through complex litigation, is surely not right.

[Kim Leadbeater]

My hon. Friend is making an excellent and powerful speech. I thank him for putting the human being back at the centre of the process; sadly, in this Committee we can forget to do that. Early on, we had Nathaniel Dye here, who is a terminal cancer patient. He has just had a 12-month prognosis. The thought of making that man jump through hoops and over hurdles breaks my heart. I understand that we have to do it, but these are the people that we are actually talking about when we discuss the Bill.

[Jake Richards]

I agree, and I hope to deal with some of the points that my hon. Friend made in her important speech. To mandate that a barrister instructed by the Official Solicitor, or indeed the panel, has to put questions to a person who may have only a few weeks left to live is not only highly inappropriate, but unworkable. What instructions is this barrister working from? Do they have to suppose that somebody who clearly has capacity does not? If not, do they ask questions about the circumstances of the person that would be asked by the panel in any event?

My hon. Friend the Member for Bradford West suggested that the Official Solicitor would be working for the person. Well, the person is coming to this panel seeking assistance, so what on earth is the Official Solicitor or their legal representative going to ask of the person they are taking instructions from? To what extent would they be allowed to go on a fishing expedition, delving deep into a person’s relationships to assess any evidence of coercion? That goes back to my original point: what are their instructions? Who is asking them to do what?

I see the force in the amendments from my hon. Friend as to burden of proof, but I deem them inappropriate. The criminal standard does not fit neatly with the more complex issues at play, such as capacity. The Mental Capacity Act states that where there is a doubt about a person’s capacity, the burden of proof is on the person seeking to establish a lack of capacity, on the balance of probabilities. That is the correct approach. In any event, if the panel has any doubts as to capacity, surely it will be obliged—as is set out in amendment 6 to clause 9, which the Committee has just accepted—to seek further psychiatric assessment. It is important to note that the panel will have powers to instruct further expert assessment and reports.

If we implement the criminal standard, the doctors who are part of the process— not only the co-ordinating doctor and the individual doctor, but treating doctors, because we should always remember that someone who is terminally ill will almost certainly be receiving treatment in the NHS—will be working to a completely different burden of proof from the panel’s. The criminal standard does not fit neatly with the innately inquisitorial nature of the panel’s role. That is important. It is very easy to look at the definition of the balance of probabilities and find weaknesses in it, but when we consider what actually happens in practice, I submit that those weaknesses are not often there.

The panel will have a conversation with the professionals and with the person and will consider the response. If doubts creep in, it will not just stop and make a decision on the balance of probabilities; it will continue to search. The more serious the doubts it encounters, the more evidence it will need for those doubts to be overcome. That is how the law has developed on the balance of probabilities in all other areas, and no doubt it will be the same in this area. Importantly, unlike with many other tribunals or courts, the decision must be unanimous, so if the social worker spots something that the psychiatrist or lawyer does not, the case will go no further.

What about the role of third parties? As I have set out before, this is a personal decision, but I also accept that no man is an island—a phrase often used by the hon. Member for East Wiltshire. The process has to strike a real balancing act: allowing third-party information to be considered, but in a proportionate manner that respects individual autonomy. To my mind, the views of third parties are not relevant. Their views on whether the person is making the best decision for themselves are not relevant. This is not a welfare decision. Equally, it must be right that third parties—family members and others—can ensure that the panel has sight of the relevant information. Even after a certificate of eligibility has been given, the co-ordinating doctor will continue to be responsible for assessing new information, and their duties will continue until the final moments, as the Bill sets out.

[Naz Shah]

Given my hon. Friend’s expertise, does he anticipate JR being allowed in the panel setting? If so, would it be before the death or after? Can the decision by the panel be judicially reviewed?

[Jake Richards]

In my mind, any decision to give a certificate of eligibility could be subject to judicial review.

Third parties can put evidence before the panel to be considered, but it is not right that third parties might challenge the application. As I have set out before, this is not a dispute but a rigorous safeguarding process. If they have information about the person’s capacity, their diagnosis or any other relevant factors, they can and must ensure that the panel—if not the doctors or indeed the police—be seized of the information. Third parties can appeal the decision by way of judicial review. That would provide for a decision that was

“wrong, or…unjust because of a serious procedural or other irregularity in the proceedings”,

per amendment (a) to new clause 17. An injunction would be applied and the matter would have to be dealt with expeditiously. It is worth saying that all the evidence suggests that that would happen incredibly rarely. In Spain—

[Daniel Francis]

My hon. Friend is about to refer to Spain, as am I. Article 10 of the relevant Spanish law gives a right of appeal on a point of law to a higher court. Does he believe that we will be in line with the position in Spain? How long does he envision judicial review taking, given that we are dealing with somebody who is at the end of their life?

[Jake Richards]

The answer to my hon. Friend’s question is yes: judicial review is clearly an exercisable option in this case. I said “expeditiously” because lots of cases are heard expeditiously; High Court judges hear cases in the middle of the night, if there is a certain urgency. In these cases, one might imagine similar circumstances, but I must stress that they would happen incredibly rarely. All the evidence suggests that. In Spain, where a not dissimilar model is in place, such an approach is rarely used by family members. The vast majority of families attend the panel because they want to offer support and love to the person who has made the choice.

[Daniel Francis]

I just want to confirm that either side has the right of appeal in Spain.

[Jake Richards]

Yes.

The other side of the coin is that we must ensure that the process is workable. In Spain, 20% of people die before the panel hears their case. We must be very careful not to create something that is so burdensome as to be completely pointless. I believe that the amendments tabled by my hon. Friend the Member for Spen Valley aim successfully between ensuring flexibility and rigour. Each case will be different—more so than in any other set of proceedings that I can imagine, and I have thought hard. There will no doubt be some that are incredibly complex, in which the panel may require further assessments and hear from relevant experts, but there will be far more that are solemn and serious but straightforward, and that is correct.

Other amendments, such as amendment (d) to new clause 21, in the name of my hon. Friend the Member for Derby North, seek to mandate certain procedural steps. While I have great respect for her as a former colleague, I fundamentally disagree with her amendment, which would require that the panel “must consider” hearing from persons who may be

“interested in the welfare of the person”.

I repeat that this is not a welfare decision. The panel, just like the High Court judge, is not saying, “What do I think is in the best interests of this person?” It is ensuring that the person has made the decision per clause 1, where we started: “settled”, “informed” and “voluntary”. We enter new ground with this law change, and that is why it is a new process, but to my mind it is safer and workable. Colleagues can be reassured, and I urge people to support the change.

[Lewis Atkinson]

I thank my hon. Friend for giving way at the end of an excellent speech. Does he agree that the provision in new schedule 2 that allows the commissioner, who would be a sitting or previous judge, to give guidance and set procedure for the operation of panels would answer some of the concerns raised by those who think that there would not be sufficient judicial input into the procedure of the panels?

[Jake Richards]

That is an important point, because the change, as drafted in the various amendments, provides for real flexibility. That may cause others some concern, but to my mind it is a reassurance, because it will mean that a weighty figure, the commissioner, will be able to set out rules and regulations for the process to make sure that it is rigorous but is not so burdensome as to be pointless.

[Liz Saville Roberts (Dwyfor Meirionnydd) (PC)]

I rise to speak to my amendment (a) to new schedule 2. The assisted dying review panel comprises a legal member and the chair, a psychiatrist member and a social worker member. I welcome this third tier of safeguarding and its range of specialities, as laid out in new clause 21.

My amendment (a) would amend paragraph 4, which concerns membership of panels, by inserting a new paragraph 4(3):

“Each member of a panel must have fluent proficiency in the Welsh language if services or functions in the Act are to be provided to an individual in Welsh.”

I emphasise the “if”, because it is in certain circumstances. I have previously touched on the requirements of the Welsh Language Act 1993 and the Welsh Language (Wales) Measure 2011. It appears that the panel can be defined as a legal proceeding and will therefore be required to follow the pre-devolution 1993 Act. Let us consider whether that is sufficient for the level of safeguarding that all Committee members want to provide.

Section 22(1) of the Welsh Language Act 1993 states:

“In any legal proceedings in Wales the Welsh language may be spoken by any party, witness or other person who desires to use it, subject in the case of proceedings in a court other than a magistrates’ court to such prior notice as may be required by rules of court; and any necessary provision for interpretation shall be made accordingly.”

I quote that as the nearest comparator. That means that the 1993 Act, in the situation we are discussing, enables people to speak Welsh and for interpreters to be provided as necessary. That gives people the right to speak Welsh, but it does not give them the right to be heard in Welsh in their own voice. If the legal personnel do not speak Welsh, their decisions will be based on the interpreted communication. The key question is whether we are content to accept the use of interpreters as intermediaries between the individual and the assisted dying panel.

Dr Sarah Davies, a consultant respiratory physician from Colwyn Bay, has written, with 78 other clinicians from Wales as co-signatories, to parliamentarians about their concerns. She states:

“In practice use of interpreters does not provide full communication of appropriate knowledge from clinician to patients. This is because interpreters are often not experienced and confident enough to discuss such complex and legal issues as assisted dying. Even the best possible practice by interpreters cannot match communicating in the person’s own preferred language. Every person whose preferred or primary language is Welsh and who communicates as a family or socially in Welsh should have access to important health information in Welsh. Any necessary assessment of capacity for purposes of consideration of assisted dying, and any assessment of coercion, must be in person and in Welsh if that is the person’s preferred language.”

Dr Davies further states that it is not possible to confidently assess the decision-making capacity of a Welsh speaker in their second language. Superficial conversations in English often fail to demonstrate that a Welsh speaker with significant health problems is confused or does not have a good understanding of their own health condition and treatment options. The presence of confusion or lack of information may become apparent only during detailed conversations with a Welsh-speaking healthcare professional. It can be extremely challenging to detect the presence of coercion, and the nuances of family dynamics will not be apparent to a non-Welsh-speaking professional when the language spoken in the family is Welsh, so it will not be possible to make any assessment of the presence or absence of coercion. That is what Dr Davies says.

The office of the Welsh Language Commissioner believes that there must be provision in the Bill to ensure that a person’s choice of language is considered, recorded and matched with further provisions, including a Welsh-speaking specialist panel. The commissioner’s office agreed that such an amendment relating to the specialist panel is very important. It stressed that a Welsh-speaking panel will be able to provide the same service in English to individuals who are not receiving assistance through Welsh, so the requirement in amendment (a) should not, in and of itself, necessarily mean recruiting more individuals or more panels. None the less, I feel that I must allay fears that it would require every member of every panel in Wales to be able to speak Welsh. It does not. That is not the intention of the amendment, nor is it in its wording. Fluent proficiency is required of all panel members only when the panel is making a decision in relation to a person whose preferred language is Welsh.

So far, the response I have received from Ministers is that this private Member’s Bill does not require specific requirements on Welsh language rights in it and that these rights are already enshrined in law. The hon. Member for Chesham and Amersham and I have written to the Minister as regards discussing how the legislation should operate in relation to Wales and devolution—he had previously committed to a meeting—but we have yet to receive a response. I have withdrawn previous amendments in anticipation of that very meeting, but in this instance—as the provision of interpreters to communicate between the individual and the people charged with being the final guardians of safeguarding is wrong—I will push the amendment to a vote, because I do not believe that the issue is covered in legislation as things stand.

--- Later in debate ---

[Rachel Hopkins]

rose—

[Jake Richards]

rose—

[Naz Shah]

I am happy to take an intervention from my hon. Friend the Member for Luton South and South Bedfordshire, and then I will come to my hon. Friend the Member for Rother Valley.

--- Later in debate ---

[Naz Shah]

I disagree with my hon. Friend. Subconscious bias operates in society; this is not about being held to account. People are not doing these things deliberately, but because they have a subconscious bias.

[Jake Richards]

My hon. Friend is making a fine speech. She said that High Court judges make mistakes, which is undoubtedly true. She also said that the panel may be guilty of unconscious bias. Is there any layer of scrutiny that would satisfy her? What does she think about jury trials?

[The Chair]

Could the hon. Lady make progress now, please?

Terminally Ill Adults (End of Life) Bill (Nineteeth sitting)

Jake Richards Excerpts

Wednesday 5th March 2025 Public Bill Committees

[Jake Richards (Rother Valley) (Lab)]

I was expecting someone else to have spoken in support of amendment 296, but I will be very brief. The tone of the debate so far has been respectful, and it should continue to be so. I hope that this will not be characterised as a personal attack on my hon. Friend the Member for York Central, who tabled the amendment, or anyone else who supports it, but this is a shocking amendment. It is shocking because I doubt that the motives behind it are to improve the Bill or make it safer. In fact, I fear that the motives are to build a political attack to support opposition to the Bill, rather than to be constructive in improving it.

I have come to that conclusion because there is no concept in any other piece of legislation, or in any healthcare guidance in operation, that would ever presuppose that a clinician would undertake a consultation, assessment or meeting that would ever put other patients in danger. I fear that this amendment has been tabled because some people are attempting to assert, perhaps not purposefully or wilfully, that the introduction of an assisted dying system would somehow force clinicians to put other patients at risk. If that is the assertion, that is wrong and—in my view—shocking. It is a shocking indictment on their view of our medical practitioners in the NHS.

[Danny Kruger]

The hon. Gentleman is impugning the motivation of his colleague, the hon. Member for York Central, who is herself an experienced practitioner in the NHS. To suggest that she has tabled this amendment improperly is a serious accusation, which I cannot believe that he really wants to make against his colleague. He said that the amendment’s intention is to suggest that assisted dying would cause problems in the NHS, but the explicit terms of the amendment are to ensure that that does not happen. Of course, no practitioner would want to take choices that would prejudice other patients’ care.

[The Chair]

Order. Mr Kruger, you are down to speak and you can make your point then. I want interventions to be short.

[Jake Richards]

I am grateful, Chair, and I can take further interventions on any further points from the hon. Gentleman, but I will deal with that one. This is not a personal criticism of my hon. Friend the Member for York Central. I do not doubt that she has good intentions. What I stated was that her opposition to the principle of the Bill is guiding some of the amendments that she has tabled, and this is one of them.

[The Chair]

Order. That is not a topic for this debate. Stick to the amendment.

[Jake Richards]

Not only do I question the motives behind amendment 296 but its necessity is—to put it politely—mind-boggling. We have attempted to navigate a balance between ensuring that, when clinicians are dealing with this process, they do so safely, and not mandating them to undertake such conversations, assessments and procedures in a straitjacket. Put simply, this amendment attempts to manage diaries. Primary legislation should not do that. We cannot use primary legislation to manage clinicians’ busy diaries, as this amendment attempts to do. It is not only unnecessary but challenges the integrity of our clinicians and what they do every day. Therefore, I will be voting against it, if it is pressed to a vote.

[The Chair]

I call Danny Kruger.

[Danny Kruger]

I was not intending to speak on this amendment, but since you have called me, Mrs Harris, I will quickly respond to the comments of the hon. Member for Rother Valley. I sincerely think that he should withdraw the suggestion that the amendment was made in bad faith and his remarks about the motivation of the hon. Member for York Central. She clearly tabled it only to make the Bill safer, which is the purpose of all the amendments, even if there might be very good reasons to disagree with them, so I regret that attack on her integrity.

On the point that we should simply rely on the integrity of clinicians—although the hon. Member for Rother Valley has not done so in respect of the hon. Member for York Central, who is herself a clinician—of course we do that. Nevertheless, the laws we make and the guidance we introduce send strong signals about priorities. The purpose of the amendment is to ensure that doctors do not feel that the obligations created by the Bill impose a duty on them to prioritise the assisted death procedure over other priorities. In fact, it would give clinicians genuine autonomy and freedom to make their own decisions—obviously, in consultation with colleagues and patients—about the appropriate prioritisation of the treatments and services they are offering.

The hon. Member for Rother Valley made the point that there is, in a sense, an attempt to suggest that the Bill should not become law because of the pressures it could impose on the NHS. I think that such pressures are a valid concern. When we create new laws, we should consider what new burdens they will place on existing services. We should consider whether the new service will be introduced and implemented safely, and its knock-on implications for the wider system.

[Jake Richards]

The point is that the amendment is not about the wider system; it is about a clinician’s individual decision making. Does the hon. Gentleman agree that that is a very different prospect?

[Danny Kruger]

Well, that concern for the individual clinician is in the context of their wider obligation to treat their patients well and to manage a resource—their own time—in a way that is equitable to all the patients they have to see. As often in these debates, we are really considering the extent to which we should be putting into the Bill an obligation on doctors to do the job that we hope that they are doing anyway. We do have such rules in the system to clarify what we expect of clinicians, however, and I think they would be appropriate in this case, given the resource requirements—which are unknowable, but with common sense one can see that they will be quite significant—that this new service would entail for many clinicians in the NHS.

[Jake Richards]

If the Government were to introduce legislation to expand the NHS’s role in how it undertakes operations in a certain area, would the hon. Member suggest that similar amendments should be added to that legislation, or it is just about this issue?

[Danny Kruger]

There is no rule that can be applied universally in the abstract. All rules take their value from how they are introduced. On the hon. Gentleman’s hypothesis, I do not in principle suggest that every new treatment and every new obligation that is created in the NHS should require laws determining how clinicians prioritise them. In the case of a new service—I am trying not to use the word “treatment”, because I do not accept it as such, but it sounds like it will be treated as an NHS treatment—that is very significant and whose resource implications are unknown, it strikes me as appropriate that, as far as possible, we should be clear that doctors should manage the resource demands placed on them by the Bill in the context of their other obligations to patients.

--- Later in debate ---

[Daniel Francis]

As my hon. Friend will know, my name is down as a supporter of amendment 6. I will get to that in due course. At the moment, I am speaking to amendment 284. I hear what my hon. Friend says—I am talking about the merits of amendment 284, but will get to amendment 6 in my closing comments.

On amendment 284, if a doctor has doubts about the capacity of an applicant, it is good practice to refer that person to a doctor with specialist expertise in that field. That would be true if the doctor was assessing the capacity of a patient to take any important decision, and is surely especially true when we are talking about a decision of this importance. I accept that people will have different views on amendment 6, when we get to it, from those they hold on amendment 284. Amendment 284 would put a duty on doctors to do something that is good practice. Most doctors in most circumstances would do it anyway, but in some cases, some may not. My hon. Friend the Member for York Central, who tabled this amendment, believes that we should write this law as tightly as possible so that doctors have that duty.

Amendment 294, which was tabled by my hon. Friend the Member for York Central, would require the doctor to base their assessment on provided evidence. Again, that is something that most doctors would do anyway in the extremely serious circumstances of a person’s applying for assisted death.

Many laws that we consider in this House relate to things that we are familiar with and understand well; but as my hon. Friend the Member for Bradford West said last week, some laws, such as this one, concern new matters. They are about things to which we need to give due consideration, as we are doing in scrutinising the Bill, because we need to understand the issues that arise. Those laws can introduce powers that could be dangerous if not properly safeguarded. This Bill, as has been accepted, needs strong safeguards. The aim of my hon. Friend the Member for York Central in tabling this amendment was to spell out that a doctor’s assessment of someone seeking assisted dying should be based on evidence. That would make it much less likely that any doctor would not pay sufficient attention to evidence they were presented with.

Lastly, as my hon. Friend the Member for Spen Valley knows, I am a long-standing of supporter amendment 6—I was in that base going into Second Reading. Alongside my concerns about clause 3, which she has heard at length, this matter was a key concern of mine going into Second Reading. I was therefore an early supporter of this amendment to change the wording around the referral from “may” to “must”. That was discussed on Second Reading. I do not want to speak for my hon. Friend, but I think she shares similar views to mine on the matter and suspect that the matter may be supported when we get to that debate.

[Jake Richards]

I will be brief. I will talk about my amendment 280, which I will not press to a vote. There remains an area that needs more exploring in this legislation—it has come up in debates already, but needs to be looked at further—namely, that a person may have capacity but have other mental health conditions that may impair their judgment. In those circumstances, a more thorough assessment than the two-doctor stage there is at the moment would be right. In reality, that is very likely to happen under the current structure of the Bill. My amendment simply attempts to make sure that it is mandatory. Having had discussions with my hon. Friend the Member for Spen Valley, I know that she is sympathetic to that.

There are amendments in the next group that aim to do the same thing. They, along with my amendment, may not be quite right. I urge the Government to look at this issue and see how we can work together to come to a conclusion, because I think that all members of the Committee would want that. I also support amendment 6, as I think everyone does.

[Dr Opher]

I apologise, Mrs Harris—I have got slightly confused with all the amendments. I do not have a speech that has been prepared for me, or anything like that, but I would like to make some comments. I think this is about the role of psychiatry and capacity, and how we deal that in the Bill. All these amendments reflect that. I would like to concentrate on whether we should actually mandate referral for all patients to a consultant psychiatrist, or adopt amendment 6, which suggests that if one of the two assessing doctors has concerns about either capacity or mental health, they should refer the patient to a psychiatrist. Those are the two choices I think we have here.

Terminally Ill Adults (End of Life) Bill (Nineteeth sitting)

Jake Richards Excerpts

Committee stage
Wednesday 5th March 2025 Public Bill Committees

[Jake Richards (Rother Valley) (Lab)]

I was expecting someone else to have spoken in support of amendment 296, but I will be very brief. The tone of the debate so far has been respectful, and it should continue to be so. I hope that this will not be characterised as a personal attack on my hon. Friend the Member for York Central, who tabled the amendment, or anyone else who supports it, but this is a shocking amendment. It is shocking because I doubt that the motives behind it are to improve the Bill or make it safer. In fact, I fear that the motives are to build a political attack to support opposition to the Bill, rather than to be constructive in improving it.

I have come to that conclusion because there is no concept in any other piece of legislation, or in any healthcare guidance in operation, that would ever presuppose that a clinician would undertake a consultation, assessment or meeting that would ever put other patients in danger. I fear that this amendment has been tabled because some people are attempting to assert, perhaps not purposefully or wilfully, that the introduction of an assisted dying system would somehow force clinicians to put other patients at risk. If that is the assertion, that is wrong and—in my view—shocking. It is a shocking indictment on their view of our medical practitioners in the NHS.

[Danny Kruger]

The hon. Gentleman is impugning the motivation of his colleague, the hon. Member for York Central, who is herself an experienced practitioner in the NHS. To suggest that she has tabled this amendment improperly is a serious accusation, which I cannot believe that he really wants to make against his colleague. He said that the amendment’s intention is to suggest that assisted dying would cause problems in the NHS, but the explicit terms of the amendment are to ensure that that does not happen. Of course, no practitioner would want to take choices that would prejudice other patients’ care.

[The Chair]

Order. Mr Kruger, you are down to speak and you can make your point then. I want interventions to be short.

[Jake Richards]

I am grateful, Chair, and I can take further interventions on any further points from the hon. Gentleman, but I will deal with that one. This is not a personal criticism of my hon. Friend the Member for York Central. I do not doubt that she has good intentions. What I stated was that her opposition to the principle of the Bill is guiding some of the amendments that she has tabled, and this is one of them.

[The Chair]

Order. That is not a topic for this debate. Stick to the amendment.

[Jake Richards]

Not only do I question the motives behind amendment 296 but its necessity is—to put it politely—mind-boggling. We have attempted to navigate a balance between ensuring that, when clinicians are dealing with this process, they do so safely, and not mandating them to undertake such conversations, assessments and procedures in a straitjacket. Put simply, this amendment attempts to manage diaries. Primary legislation should not do that. We cannot use primary legislation to manage clinicians’ busy diaries, as this amendment attempts to do. It is not only unnecessary but challenges the integrity of our clinicians and what they do every day. Therefore, I will be voting against it, if it is pressed to a vote.

[The Chair]

I call Danny Kruger.

[Danny Kruger]

I was not intending to speak on this amendment, but since you have called me, Mrs Harris, I will quickly respond to the comments of the hon. Member for Rother Valley. I sincerely think that he should withdraw the suggestion that the amendment was made in bad faith and his remarks about the motivation of the hon. Member for York Central. She clearly tabled it only to make the Bill safer, which is the purpose of all the amendments, even if there might be very good reasons to disagree with them, so I regret that attack on her integrity.

On the point that we should simply rely on the integrity of clinicians—although the hon. Member for Rother Valley has not done so in respect of the hon. Member for York Central, who is herself a clinician—of course we do that. Nevertheless, the laws we make and the guidance we introduce send strong signals about priorities. The purpose of the amendment is to ensure that doctors do not feel that the obligations created by the Bill impose a duty on them to prioritise the assisted death procedure over other priorities. In fact, it would give clinicians genuine autonomy and freedom to make their own decisions—obviously, in consultation with colleagues and patients—about the appropriate prioritisation of the treatments and services they are offering.

The hon. Member for Rother Valley made the point that there is, in a sense, an attempt to suggest that the Bill should not become law because of the pressures it could impose on the NHS. I think that such pressures are a valid concern. When we create new laws, we should consider what new burdens they will place on existing services. We should consider whether the new service will be introduced and implemented safely, and its knock-on implications for the wider system.

[Jake Richards]

The point is that the amendment is not about the wider system; it is about a clinician’s individual decision making. Does the hon. Gentleman agree that that is a very different prospect?

[Danny Kruger]

Well, that concern for the individual clinician is in the context of their wider obligation to treat their patients well and to manage a resource—their own time—in a way that is equitable to all the patients they have to see. As often in these debates, we are really considering the extent to which we should be putting into the Bill an obligation on doctors to do the job that we hope that they are doing anyway. We do have such rules in the system to clarify what we expect of clinicians, however, and I think they would be appropriate in this case, given the resource requirements—which are unknowable, but with common sense one can see that they will be quite significant—that this new service would entail for many clinicians in the NHS.

[Jake Richards]

If the Government were to introduce legislation to expand the NHS’s role in how it undertakes operations in a certain area, would the hon. Member suggest that similar amendments should be added to that legislation, or it is just about this issue?

[Danny Kruger]

There is no rule that can be applied universally in the abstract. All rules take their value from how they are introduced. On the hon. Gentleman’s hypothesis, I do not in principle suggest that every new treatment and every new obligation that is created in the NHS should require laws determining how clinicians prioritise them. In the case of a new service—I am trying not to use the word “treatment”, because I do not accept it as such, but it sounds like it will be treated as an NHS treatment—that is very significant and whose resource implications are unknown, it strikes me as appropriate that, as far as possible, we should be clear that doctors should manage the resource demands placed on them by the Bill in the context of their other obligations to patients.

--- Later in debate ---

[Daniel Francis]

As my hon. Friend will know, my name is down as a supporter of amendment 6. I will get to that in due course. At the moment, I am speaking to amendment 284. I hear what my hon. Friend says—I am talking about the merits of amendment 284, but will get to amendment 6 in my closing comments.

On amendment 284, if a doctor has doubts about the capacity of an applicant, it is good practice to refer that person to a doctor with specialist expertise in that field. That would be true if the doctor was assessing the capacity of a patient to take any important decision, and is surely especially true when we are talking about a decision of this importance. I accept that people will have different views on amendment 6, when we get to it, from those they hold on amendment 284. Amendment 284 would put a duty on doctors to do something that is good practice. Most doctors in most circumstances would do it anyway, but in some cases, some may not. My hon. Friend the Member for York Central, who tabled this amendment, believes that we should write this law as tightly as possible so that doctors have that duty.

Amendment 294, which was tabled by my hon. Friend the Member for York Central, would require the doctor to base their assessment on provided evidence. Again, that is something that most doctors would do anyway in the extremely serious circumstances of a person’s applying for assisted death.

Many laws that we consider in this House relate to things that we are familiar with and understand well; but as my hon. Friend the Member for Bradford West said last week, some laws, such as this one, concern new matters. They are about things to which we need to give due consideration, as we are doing in scrutinising the Bill, because we need to understand the issues that arise. Those laws can introduce powers that could be dangerous if not properly safeguarded. This Bill, as has been accepted, needs strong safeguards. The aim of my hon. Friend the Member for York Central in tabling this amendment was to spell out that a doctor’s assessment of someone seeking assisted dying should be based on evidence. That would make it much less likely that any doctor would not pay sufficient attention to evidence they were presented with.

Lastly, as my hon. Friend the Member for Spen Valley knows, I am a long-standing of supporter amendment 6—I was in that base going into Second Reading. Alongside my concerns about clause 3, which she has heard at length, this matter was a key concern of mine going into Second Reading. I was therefore an early supporter of this amendment to change the wording around the referral from “may” to “must”. That was discussed on Second Reading. I do not want to speak for my hon. Friend, but I think she shares similar views to mine on the matter and suspect that the matter may be supported when we get to that debate.

[Jake Richards]

I will be brief. I will talk about my amendment 280, which I will not press to a vote. There remains an area that needs more exploring in this legislation—it has come up in debates already, but needs to be looked at further—namely, that a person may have capacity but have other mental health conditions that may impair their judgment. In those circumstances, a more thorough assessment than the two-doctor stage there is at the moment would be right. In reality, that is very likely to happen under the current structure of the Bill. My amendment simply attempts to make sure that it is mandatory. Having had discussions with my hon. Friend the Member for Spen Valley, I know that she is sympathetic to that.

There are amendments in the next group that aim to do the same thing. They, along with my amendment, may not be quite right. I urge the Government to look at this issue and see how we can work together to come to a conclusion, because I think that all members of the Committee would want that. I also support amendment 6, as I think everyone does.

[Dr Opher]

I apologise, Mrs Harris—I have got slightly confused with all the amendments. I do not have a speech that has been prepared for me, or anything like that, but I would like to make some comments. I think this is about the role of psychiatry and capacity, and how we deal that in the Bill. All these amendments reflect that. I would like to concentrate on whether we should actually mandate referral for all patients to a consultant psychiatrist, or adopt amendment 6, which suggests that if one of the two assessing doctors has concerns about either capacity or mental health, they should refer the patient to a psychiatrist. Those are the two choices I think we have here.

--- Later in debate ---

[Jake Richards]

The hon. Lady has set out the process, but I believe she may have missed an important juncture in the Bill. If there are any doubts as to capacity, then the person would be referred to a psychiatrist for a full assessment.

[Rebecca Paul]

That is a “may” rather than a “must”. I hope that we would move to “must” in that event.

--- Later in debate ---

[Sean Woodcock]

I will speak briefly on amendment 21, although I will commend my hon. Friend the Member for Ashford for his contribution to the debate. He speaks with clear expertise and experience, and a real love for his profession, and we all benefit greatly from his insights.

Over the last few weeks, I have found myself voting the opposite way from the promoter of the Bill on a number of occasions, but I am not opposed to assisted dying in principle. My issue is more about whether we can ever make it safe enough; the difference between us is marginal. One thing that has been apparent throughout these debates is her passion for improving the training for those involved in palliative care, and in the wider NHS and social care generally.

That is why I want to speak to amendment 21. In the witness testimony, particularly from Rachel Clarke, there was a lot of concern about whether coercion and people being put under pressure to go for assisted dying would be picked up, and whether the NHS was geared up for that. I think that this amendment, tabled by my hon. Friend the Member for Lowestoft, goes some way to addressing that.

I do not think training is a silver bullet, hence my votes over previous weeks, but it would make a massive difference. That is true not only for the implementation of the Bill; it would have wider benefits for the NHS, social care and palliative care more generally. Even though those are not necessarily in scope of the Bill, I suggest that they are good things, which is why Committee members should get behind amendment 21.

[Jake Richards]

I want to speak to amendment 57. I do not intend to press it to a vote, but I will explore whether and how the Bill could be improved in terms of the relationship between the two doctors. There is a tension here. On one hand, we want to keep the two doctors separate, because the second one can then assess the person with a fresh perspective. We have had a debate about where there is a relationship between the doctors, which could cause problems as well. On the other hand, the evidence that we heard from some witnesses who gave evidence to the Committee was that decisions or assessments taken together can be more efficient and safer.

We may come back to this issue when we consider clause 9—next week, I presume, looking at the clock—but I wanted to raise it now. I have had conversations with the promoter of the Bill about it, but we also need to have conversations with Ministers about the best way to regulate the relationship between the two doctors to ensure that it is safe in the way that it keeps them separate but allows them to confer.

[Naz Shah]

I rise to speak to amendment 21, tabled by my hon. Friend the Member for Lowestoft, which is about the second, independent doctor. We debated amendment 20 earlier, and I am genuinely very pleased that the promoter of the Bill accepted that amendment. Some of what I would like to say now will be repetition, because it is a similar amendment, but I will try to keep my remarks contained and shorter.

I am not sure whether the promoter of the Bill is planning to accept amendment 21 as well as amendment 20 —for both doctors. I will be happy to give way if she wants to clarify that now.

Terminally Ill Adults (End of Life) Bill (Sixteenth sitting)

Jake Richards Excerpts

Committee stage
Tuesday 4th March 2025 Public Bill Committees

[Dr Opher]

I absolutely agree. We are imagining that the doctors will all be independent and will not know anything about what other doctors have said, but there will be communication and access to medical records, and they will also tell the original doctor what their opinion is, and so on.

If we accept these amendments, we risk over-embroidering the Bill, which will make it almost impossible for doctors to say anything in a consultation. We must leave that free, because that is a central tenet of medical care, and if we put laws around it, there will be legal process over the medical consultation, and doctors will be frozen with fear about breaking the law. They are regulated by the GMC, and we are all terrified of referrals to the General Medical Council for that very reason: because we are trying to operate at the best standard that we can. I truly understand the amendments, but I do not think they will make the Bill any safer, and that is what we are all here for.

[Jake Richards (Rother Valley) (Lab)]

I am very sympathetic to the amendment and have thought long and hard about it. Can my hon. Friend explain to me, from his experience, but also from looking at the Bill and speaking to others, the effect of clause 4(4)(b)? As a non-clinician layperson, it appears to me that if a medical practitioner is discussing the likely effect of any treatment, then by its very nature that would lead to a discussion about prognosis, and the uncertainty and certainty around that.

[Dr Opher]

What my hon. Friend points out is absolutely true. The Bill’s drafting is simple but very effective. For prognosis, for example, it says that it is

“reasonably…expected within 6 months.”

As we have discussed many times in this Committee, prognosis is not exact; it is an estimate. It suggests that the patient has a terminal illness—that is to say, the illness will lead to their death. All we are arguing about is exactly when that will happen. It is reasonable to say, as doctors already do, “It is likely that you have six months to live.” That is not exact—as doctors, we cannot predict the future, even if people think we can. I totally accept that. However, we can make estimates as to what is likely to happen.

As my hon. Friend just mentioned, there are lots of really good news stories of people living longer than their prognosis. However, for the Bill to be effective, and to give relief to people who genuinely need it, we have to have a prognosis, based on medical evidence, of six months.

Terminally Ill Adults (End of Life) Bill (Fifteenth sitting)

Jake Richards Excerpts

Committee stage
Wednesday 26th February 2025 Public Bill Committees

[Jake Richards (Rother Valley) (Lab)]

I have been listening to the argument in some detail. Is there not a danger here of trying to translate the dry words of clause 4 to the conversations that naturally happen between clinicians and patients? Subsection (3) attempts to give some discretion as to when, how and whether to raise this prospect, instead of making it mandatory on any prognosis of terminality.

[Danny Kruger]

I recognise that it is an attempt to give maximum leeway to doctors. I think that is dangerous and puts doctors in a very difficult position. The BMA made the point that it is appropriate to enable doctors to raise this option as if it were just another treatment, even though it has also said it is not just another treatment.

I would challenge the BMA with the Medical Defence Union, which is the union that supports doctors in litigation. It points out, more correctly, that this is the worst of all worlds for doctors because they would be liable to complaints in either situation: if they do not raise it, a complaint can be made against them for not having done so; and if they do raise it, a complaint can be made against them on those grounds. We are being extremely unclear by leaving it entirely up to doctors. As I have said, it is not clear to me the circumstances in which it would be appropriate for a doctor to suggest an assisted death to somebody who has not raised it themselves. I would very much like to hear somebody tell me what those circumstances might be and to paint a scenario for us in which it is appropriate.

--- Later in debate ---

[Naz Shah]

I agree that that is what the evidence shows us, and there are many concerns in other jurisdictions as well. I will come back to that distinction.

[Jake Richards]

The evidence that I have heard, both in Committee and from other sources, shows that the gagging clause leads to complete absurdities. Doctors feel completely unable to look after their patients and inform them of their options, and this leads to conversations that involve winks and nods. That is exactly what the Bill is trying to stop. Does my hon. Friend agree? I sense not.

[Naz Shah]

Unfortunately, I do not agree. I do not even agree with the term “gag clause”, which has been used a few times now. From where I stand, this is not a gag clause; it is an amendment that protects those who are most vulnerable. In Committee I have referred continuously to the most vulnerable, as have other hon. Members, and I will return to the evidence from Dr Jamilla Hussain. I do not agree with my hon. Friend’s position.

We need to listen to what doctors who are treating vulnerable patients say about the risks to those people, and then we need to amend the Bill to reduce those risks. Bluntly, there is a choice here. The British Medical Association says that if the Bill becomes law, doctors should be able to raise the subject of assisted dying with patients. Palliative medicine doctors such as Rachel Clarke and Jamilla Hussain, who deal with this every day, are deeply concerned by that prospect, and they want us to avoid it. There is no papering over this: the doctors disagree and it is up to us—the Committee— as lawmakers, and this House, to decide which of them makes the stronger case.

I genuinely think that the BMA makes a strong case. There is no doubt in my mind that it is motivated by empowering doctors to give the best possible care to their patients. It is natural that the BMA looks at existing practice among doctors. Currently, doctors can discuss all possible treatments and pathways with patients—the key words being “possible treatments and pathways”—so the BMA makes the case that that should also be true for assisted death.

In the end, however, I cannot agree with the BMA for one reason: assisted dying will be qualitatively different from every previous kind of medical intervention that has been legally permitted in this country. We have never permitted doctors to legally assist patients to take lethal drug combinations with the sole purpose of ending their lives. Some things really are different from what has come before; if the Bill becomes law, assisted dying will be one of those things.

Terminally Ill Adults (End of Life) Bill (Thirteenth sitting)

Jake Richards Excerpts

Committee stage
Tuesday 25th February 2025 Public Bill Committees

[Naz Shah]

If we take that number, then that 30% or 40% who do not take that decision is maybe a few hundred people. However, the truth from Professor Sleeman’s evidence is that we are talking about thousands of people who are misdiagnosed every single year. She was talking about 3,516 who lived longer than expected. Yes, I recognise and value my hon. Friend’s comment that 30% or 40% of people do not take up assisted dying, but—perhaps I will talk about this when I move on to the next amendment—there is also a risk. If we go back to the Bill promoter’s intention to make the wording tighter, then surely this is a safeguard that she would support, just to ensure that we are making it as tight as we possibly can.

[Jake Richards (Rother Valley) (Lab)]

Can my hon. Friend clarify for me what she means by “reasonable certainty”, and how that differs from the clause as drafted? Can she also explain why, in her amendments, normal language around the burden of proof, such as “on the balance of probabilities” or “beyond reasonable doubt” is not used?

[Naz Shah]

First, this is not an issue for a tribunal, where it would be on the balance of probabilities; it is not an issue for a court of law or a criminal court, where we would be using proof beyond reasonable doubt. What I am trying to demonstrate is that doctors, in those diagnoses where they do get it right, have much more certainty. It might be that people have six months to live because they have different types of cancer. I am certainly not a clinician or an oncologist, but I know from the evidence we have had and from speaking to people that some people’s diseases—the specialists know better—have a trajectory of plateauing out and then dropping right at the end and some have a jagged kind of decline. Some of those diseases can be predicted with much more clarity than others. On the surface of it, in September, it might be the case for somebody that that is within the time—as for one lady who was told that she would not have more than six months to live. She is the founder of the Music of Black Origin awards and I was with her last week. She was absolutely fighting; she was not supposed to make it to that day. It is for the medics to decide—it is not for me to decide—but I would like medics to have much more certainty than they currently do, so that we would not have 47% of cases being misdiagnosed. That is what I am trying to get to, but I thank my hon. Friend for his intervention.

I argue that there is still a danger of using the standard prognosis that is currently in the Bill. The current research into doctors’ prognoses indicates that about half of their estimates are incorrect. My amendment would hold doctors to a higher standard of certainty. Under the measure, they would be explicitly held to a prognosis that death would occur with reasonable certainty within six months, and that that would have to be true even if the patient underwent all recommended treatment.

To go back to my hon. Friend’s intervention, this amendment is about raising the bar for how our medics make decisions. I submit that it would be a stronger test than the one currently included in the Bill. My hon. Friend the Member for Spen Valley has frequently stated that she wishes to create a Bill with the toughest safeguards in the world. I keep coming back to that, because the whole purpose of speaking to all these amendments is to put in opportunities to try to strengthen the Bill. By their nature, all these amendments reflect hon. Members’ concerns. This amendment would tighten the prognostic standard required of doctors and would therefore contribute towards tightening the Bill’s safeguards. I hope that hon. Members support it.

Finally, I turn to amendment 402. I will repeat a lot about anorexia, but it is an important amendment. I have tabled it for a simple but extremely important purpose: to prevent people from qualifying for assisted dying by stopping eating and drinking to the degree that they develop severe malnutrition, such that a doctor would give them a prognosis of six months to live. It specifically aims to protect people with severe eating disorders, including anorexia nervosa, and would also protect people with a severe wish, as one of the psychiatrists who testified before the Committee put it, to “hasten death”. I hope that my hon. Friend the Member for Spen Valley, and all other Committee members, will support this amendment.

Let us make no mistake: the Bill, as currently drafted, has a horrible loophole that all of us should seek to close. We know that anorexia sufferers and other people with eating disorders can and do stop eating to the point where they are dying of malnutrition. We should not allow such people to qualify for assisted death. Unfortunately, that is not a hypothetical danger; it is happening.

We know from the evidence that the Committee has received that that has happened in other countries. A group of eight experts on eating disorders submitted written evidence TIAB54 to the Committee some weeks ago. The experts included Chelsea Roff, who has been referred to many times in this Committee, and who gave clear testimony before the Committee, as well as seven medical doctors from hospitals in the UK, the US and Canada.

I hope that all Committee members have read the evidence, but I would understand if they had not, because we have had nearly 400 pieces of evidence to go through and very little time to read it. It seems to me, however, that if we are trying to write the best possible Bill, with the strongest possible safeguards, we have to pay the written evidence of experts the attention that it deserves. In their written evidence, that group of experts said:

“Patients with severe eating disorders frequently experience profound psychological distress and may express a desire to die. While this may appear to reflect a clear and informed wish, it is often a symptom of their psychiatric condition, which is remediable with appropriate treatment.”

The experts found that at least 60 patients with eating disorders received assisted death in several jurisdictions worldwide, including the US, Canada, the Netherlands and Belgium. I stress the phrase “at least 60” because we cannot be entirely sure that that is the full total. It is sadly the case that some jurisdictions are much more painstaking and transparent in the data they publish on assisted death than others.

In itself, it is tragic that people died in that way, but two things surely make the fact even worse. There are certainly men with eating disorders, but this is a problem that disproportionately affects women and girls. We know that the incidence of anorexia nervosa is much higher among women than among men in every age group. That is tragic. In every case we know of where a person with an eating disorder received an assisted death, that person has been a woman. I say it again: we cannot allow the Bill, as currently written, to stand. The Labour Government was elected with a mandate to reduce violence against women and girls. We surely cannot pursue that goal while at the same time increasing the vulnerability of women and girls who have eating disorders. There is nothing in the Bill as it currently stands that would stop doctors signing off on assisted death for someone who had starved themselves into malnutrition.

The courts in England and Wales have already begun accepting that some people with anorexia have reached a terminal stage. In the Court of Protection case, The NHS Trust v. L & Others, which took place in 2012, a 29-year-old with severe anorexia was described in the ruling as follows:

“The prospects of her recovery overall approach zero…given that it is extremely unlikely that Ms L will recover from her anorexia…in best interests to move to palliative care if L…in terminal stage of her illness.”

The right hon. Member for North West Hampshire raised the Court of Protection. There are 10 cases where the Court of Protection has made rulings. Of them, only one case, in 2012, ruled that the young lady could be force-fed.

Terminally Ill Adults (End of Life) Bill (Fourth sitting)

Jake Richards Excerpts

Wednesday 29th January 2025 Public Bill Committees

[The Chair]

Jake Richards was not called for the last panel, so we will start with him.

[Jake Richards (Rother Valley) (Lab)]

Q Thank you for those introductory statements. I have a question for Mr Amin regarding the current operation of the Mental Capacity Act 2005, and how the Court of Protection approaches that issue. The Bill as currently drafted essentially defers to the Act, and I wondered if you have any reservations about that, or any thoughts that you could offer the Committee?

Yogi Amin: Reservations—no. In fact, I wholly recommend and support the idea as drafted to defer to the Mental Capacity Act for capacity assessments. I have been working in this area for over 20 years, before and after the Mental Capacity Act came in, and I have done cases all the way up to the Supreme Court, as well as day-to-day different cases around the country. It is well understood how capacity assessments are done, and it is ingrained into the practice of practitioners generally and of legal practitioners in the courts. Certainly when I give training to advocates, doctors and so on, it is well understood how to apply the test. That could be adapted for this particular decision, which is done here. In the past couple of years, we had a decision in the Supreme Court which settled how to approach the question of capacity, and to disturb that would concern me.

[Jake Richards]

Q To be clear, would it concern you because it would cause confusion?

Yogi Amin: It is a well settled and understood approach to the law, and producing a new one would throw up a whole new conundrum, where people would be questioning how to approach it, etc. It is not broken—it works well.

[The Chair]

That was a specific question to Mr Amin, but it is an important issue. Does anyone else wish to come in, briefly please?

Chelsea Roff: One thing I would like to highlight in our study is that all 60 people who died—young women, mostly—were found to have mental capacity to make the decision to end their life, so I worry that mental capacity will not be an effective safeguard to prevent people with eating disorders from qualifying under the Bill.

I also note that Oregon and California, where I am from and where we have found cases, have an additional safeguard to mental capacity. That is, if there are any indications that the person might have a mental disorder, that person must be referred for a mental health assessment. It is important not to make a false equivalence between mental capacity and mental health.

We could, for instance, have a person who has a prognosis of six months or less, but their wish to die is emerging from severe depression, from suicidality. We saw very high rates of suicidality and depression: 89% were depressed and nearly half chronically suicidal when they died. Physicians emphasised, still, that the wish to die was not emerging from a mental illness, despite them having diagnosed mental illness.